Category Archives: Resources

Facing a vaccine price increase….what can you do?

Price increases in general are not fun.  Fortunately in the case of vaccines, buying group members receive 30 to 90 days of advanced notice before the new pricing becomes effective.  This timing enables a practice to take action to minimize the negative impact to their bottom line.  Here are several steps you can take:

  • Notify your payers of the change and refer them to the updated CDC Private Sector List price as the benchmark for reimbursements.
  • Update your billing rates accordingly
  • Purchase a refrigerator and freezer large enough to store extra vaccines purchased during this discount period
  • Strategically time your purchases so that you can purchase as much product as you can at the pre-increase price
  • Check all invoices to make sure the pre-increase price is honored through the implementation date

If you have any questions about the overall financial health of your immunization services, contact CPP for a free analysis!

AAP advocacy leads to change in coding for vaccine administration.

Medically unlikely edits (MUEs) are the daily limit placed by the Centers for Medicare & Medicaid Services (CMS) on billed CPT codes and are often used by private payers to reduce the likelihood of coding errors. With the assistance of the Section on Administration and Practice Management (SOAPM) and the Committee on Coding and Nomenclature (COCN), the Academy worked with CMS to update the MUEs associated with the vaccine administration codes 90460 and 90461 based on clinical rationale.

The updates are as follows:

  • Effective April 1, 2017, the MUE for 90460 will go from 6 to 9
  • Effective July 1, 2016, the MUE for 90461 will go from 5 to 8                                          (Since this update was published January 1, 2017 but was effective July 1, 2016, any denials since this date should be appealed.)

If you receive denials for MUEs, email the AAP coding hotline at aapcodinghotline@aap.org.  (Full Article)

How is your practice doing with adolescent vaccination coverage?

There are many challenges related to adolescent vaccinations that practices are currently facing:

• How are our HPV vaccine completion rates?
• Should we promote meningococcal B vaccine universally or just to high-risk patients?       Which vaccine should we stock?
• Do patients who already had HPV-4 or HPV-2 need HPV-9?
• How many of our patients have received their 2nd dose of meningococcal ACWY vaccine?

Two new action briefs have been developed with the assistance of the Vaccine Education Center at the Children’s Hospital of Philadelphia to help practices address these issues and provide ideas you can use in your own practice.

Immunization Administration Coding

We have received several questions from our members in the last month regarding proper coding and documentation for immunization administration.  There are 6 codes that apply:

Under 19, with counseling on each vaccine component:
90460 – first component
90461 – additional component

Under 19, without counseling on each vaccine component OR over 19:
90471 – first injection
90472 – additional injection
90473 – first oral or intranasal administration
90474- additional oral or intranasal administration

In order to bill 90460 and 90461, counseling by a physician or other qualified healthcare professional must be performed on each vaccine component and it must be documented in the medical record.

Please refer to the AAP’s Frequently Asked Question (FAQ) document that helps address vaccine administration coding questions for more information.

Helpful hints for providing current Vaccine Information Statements (VISs) to your patients!

The Immunization Action Coalition has put together a guide, making it easy to provide this valuable resource to your patients and families prior to each immunization.  Did you know that the VISs are specifically formatted so that they can be transmitted electronically via text or your patient portal?  Here is a link to the current VISs published by the CDC.

Back to school: Vaccine Resources for Patients

Back to school is always a busy time for you and your patients.  Help make the most of the time you spend with your patients by providing resources that will help address concerns about vaccines and lead to a productive discussion during the office visit.  Helpful patient resources are offered by the following organizations:

Centers for Disease Control and Prevention

Children’s Hospital of Philadelphia Vaccine Education Center

Immunization Action Coalition